Provider Demographics
NPI:1508897893
Name:H L SULIT MEDICAL PROFESSIONAL CORP
Entity Type:Organization
Organization Name:H L SULIT MEDICAL PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-436-9771
Mailing Address - Street 1:825 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4225
Mailing Address - Country:US
Mailing Address - Phone:562-436-9771
Mailing Address - Fax:562-436-1067
Practice Address - Street 1:825 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4225
Practice Address - Country:US
Practice Address - Phone:562-436-9771
Practice Address - Fax:562-436-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30161207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301611Medicaid
CAA30161Medicare PIN
CA00A301611Medicaid